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FOR OFFICE USE: itAPPLICATION FOR SANITATION PERMIT <br /> --------=---------------------- '----,-fr- ----�------ -- Permit No,. <br /> (Complete in Triplicate) <br /> --'--'- <br /> � Date Issued <br /> _ <br /> __-__-_______----_-__-___-__ <br /> -____-- This Permit Expires t Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described This application is a e in compliance with County,Ordinance No. 549 and existing Rules and Regulations: <br /> X ---- <br /> JOB ADDRESS/LOCATION f?J�--ra_��rr�Q.�----- ------------------------------------------s�,��_L�`r-�- __-- -- -----:-_----- <br /> Owner's Name ----41`1�� - - - ----,----- ----Phone --- <br /> Address ---------- L4?1?-e•---- "e ---------- City f` � _ <br /> ----------------------------------------- <br /> Contractor's Name .....MX�A:1'L.._...j_- -l�C.... ' -.----.License # --- '� --- Phone � _ <br /> 1. <br /> Installation will serve: Residence 2"A"partment House❑ Commercial :❑Trailer Court ❑ f <br /> Motel ❑Other -I <br /> ' I C� <br /> Number of living units:...I-------- Number of bedrooms ------_--Garbage Grinder .. -_ Lot Size ...-.__.-�..r'4----------------------- <br /> Water Supply: Public System and name -! E I =- --------- ------------Private <br /> 3 <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E-] 'Peat E] Sandy Loam :Q Clay Loam❑ 1 <br /> i ! <br /> Hardpan Adobe ❑: Fill Material ___________ If yes,type �--------.------------------ <br /> wells,(Plot plan, showing size of lot, location of system in relation to.we , buildings, .etc. must1be placed on reverse side.).. '? <br /> _ f f t <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> X- � ..a..—.. �r <br /> PACKAGE TREATMENT ) SEPTIC TAMC {� 5ize__. _ . .. ._. ..._ __ _-- Liquid Depth ..._.4 <br /> Capacity Jap...,.. Typetp"S - Material _2 '__ No. Compartments ___ _-_._._:.... <br /> .Distance'to nearest. Well ....�S__0------------------------Found6tion ---------------- Prop. Line ----- �_:------'.� <br />` LEACHING LINE [� No. of"`Lines � Length each line` � `"" ... __-_V490 <br /> -- -------------- _ - - Total Length -------------- <br /> 'D' Box• --~^w.. T' T . �.:..r�; lr -� <br /> "1 __. -- _,.,, <br /> ' �yilter Material I¢ -"'"Deptfi,Filter Material _... ...... .... .. -------.---------, <br /> Distance to nearest: Well ___ ------- foundation Property Line Line _---� .. <br /> .......... ..... <br /> —SEEPAGE PIT Depth __A- --`-- ��_D- �� __ <br /> Diameter Number M- '�--------- _--- Rock filled Yes ®-­`�No 0 <br /> Water Table bepth',i_= c, M---------------------- Site ---- -- ->----------------- <br /> t Distance to-nearest Well ..._.../-Q ._-._................Foundation -�a_---_.--_. Prop:nLine ....>6.------------ _ <br /> REPAIR/ADDITION{Prev."'Sanitation Permit# ----------- --------------------------------- Date ----------------•-.---------------) <br /> Septic Tank (Specify Requirements) --------------=- ---------------r------------------------------------------------------------------------- --, •-----------------------•--- <br /> Disposal Field (Specify Requirements) ---- - - -----.�! $/ 1 .___-___9 B_ �,Y/Sll ---- ----- <br /> ----------------------------------=------------------------------------------------------------------.------------------------------------------------------- .------- - _.. <br /> - - -----------------------`--_--'_=----"-------"`"-`--------------------------------`------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any/person in such manner <br /> as to become sRbiqct to Wor an's VAgnpe9As4*on laws of California." } <br /> k <br /> Signed-- -- Q - '-� - 1 Owner r <br /> B ----- Title " r ' <br /> f other than owner) ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ---------------------------------------------------------- -------- DATE ...� ------{-------- <br /> BUILDING PERMIT ISSUED .. - ---------------- ----------------" f----- weo . DATE.---------------------$-----Q----------- ' <br /> - <br /> v�/¢" L"° <br /> -4ADDITIONAL COMMENTSALr..+_ - ------ ---i <br /> ------n-- - - - <br /> J-' ia? <br /> g-2J <br /> Up <br /> ,Fina Inspection by: kK Ef" <br /> Date <br /> --------------------------------- b <br /> AN J A AL HEALTH DISTRICT <br /> E. 9 1-'68 Rev. 5M. l <br />